Grant: Team Grant: Late Life Issues - LOI

As society ages, increasing numbers of older patients are being admitted to Intensive care for life-sustaining treatments. Historically, very elderly critically ill patients have been systematically excluded from many clinical trials so there is very little evidence to inform what best practices should be for this older population when admitted to ICU. We have conducted several observational studies of this very elderly patient population and determined that there are many problems with communication and decision-making, that the care provided is not based on patient/family wishes or values. In some cases, this leads to a prolonged dying experience, family dissatisfaction with critical care, and poor quality end of life care. Moreover, the older patients who do survive their critical illness have a significant decline in their physical function even 1 year later. Our team proposes to generate new evidence and synthesize existing evidence in order to create an evidence-based care pathway to define the best care that very elderly patients should receive in ICU, other parts of the hospital, and at home. Our focus is on improving communication and decision-making with these patients and their families and ensuring that optimal nutrition and rehabilitation practices are being realized. We will work actively with our stakeholder groups that include patient and family representatives, researchers, clinicians, and health care administrators to develop, implement and evaluate these best practices in Intensive Care Units in Alberta and elsewhere. A major emphasis of our team grant will be to partner with families in developing and implementing these best practices to their sick loved ones. The knowledge we generate has the potential to impact quality care for very elderly, sick, vulnerable patients and their families in Canada and, working with our partners, can significantly impact care worldwide.